Who benefit from school doctors' health checks: a prospective study of a screening method

Abstract

Background: School health services provide an excellent opportunity for the detection and treatment of children at risk of later health problems. However, the optimal use of school doctors' skills and expertise remains unknown. Furthermore, no validated method for screening children for school doctors' assessments exists. The aims of the study are 1) to evaluate the benefits or harm of school doctors' routine health checks in primary school grades 1 and 5 (at ages 7 and 11) and 2) to explore whether some of the school doctors' routine health checks can be omitted using study questionnaires.

Methods: This is a prospective, multicenter observational study conducted in four urban municipalities in Southern Finland by comparing the need for a school doctor's assessment to the benefit gained from it. We will recruit a random sample of 1050 children from 21 schools from primary school grades 1 and 5. Before the school doctor's health check, parents, nurses and teachers fill a study questionnaire to identify any potential concerns about each child. Doctors, blinded to the questionnaire responses, complete an electronic report after the appointment, including given instructions and follow-up plans. The child, parent, doctor and researchers assess the benefit of the health check. The researchers compare the need for a doctor's appointment to the benefit gained from it. At one year after the health check, we will analyze the implementation of the doctors' interventions and follow-up plans.

Discussion: The study will increase our knowledge of the benefits of school doctors' routine health checks and assess the developed screening method. We hypothesize that targeting the health checks to the children in greatest need would increase the quality of school health services.

Trial registration: ClinicalTrials.gov Identifier: NCT03178331 , date of registration June 6 th 2017.

Keywords: Children; Health check; Questionnaires; School health services; Screening; Student.

Conflict of interest statement

Ethics approval and consent to participate

The coordinating ethics committee of the Hospital District of Helsinki and Uusimaa (HUS) has approved the study protocol (HUS/2174/2017). Permissions for the study have been obtained from the Departments of Social Services and Healthcare and the Departments of Education from all participating municipalities. Informed consent will be obtained from all participating children, parents, nurses, teachers and doctors. Consent covers also the storage of the research data for 10 years after the end of the study for possible further research in school health services by the research group. Personal data will be destroyed 5 years after they were collected. No biological specimens are collected for the purpose of this study.

Data collection is partly organized digitally while taking care of appropriate data protection. The confidentiality of participants is protected by using an encryption key prior to data analyses. The key is stored separately from study data. All data will be treated according to national data security laws.

If a significant concern were reported in the study questionnaires that was not discussed during the health check a new appointment will be arranged if necessary.

Consent for publication

Not applicable.

Competing interests

The authors declare that they have no competing interests.

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Figures

Fig. 1

Current extensive health check in primary school grades 1 and 5 in Finland

Fig. 2

Study design

Fig. 3

Flow chart of population-based recruitment

Fig. 4

Recruitment of doctors in 4 municipalities. In Helsinki all school doctors who gave consent were chosen. The school doctors chose 2 different schools from different socioeconomic areas of Helsinki if possible. In Tampere, Kirkkonummi and Kerava the chief physician chose school doctors who had different education and experience of working as a school doctor and schools from different socioeconomic areas of the municipality. The school nurses and teachers were chosen according to the school doctors’ schools. In Helsinki 2 nurses refused to participate and the doctor chose another school instead

Fig. 5

Timeline of the study

Fig. 6

Categorization of parent’s and nurse’s study questionnaire responses. *The free description of the concern can alter the categorization to 1) NEED+ for school doctor’s health check: If there is concern such as parenthood or the relationship between parent and child, sleep problems, behavior problems in the class, recurrent joint pain/headaches, heel pain, acne, a mole, 2) CONSULTATION, (a) of doctor by nurse if the nurse has only little concern about growth or posture and a wish for school doctor’s assessment, (b) of nurse by parent if the parent has concern about: growth but the nurse is not concerned about it, the amount of sleeping, growth pain

Fig. 7

Categorization of teacher’s study questionnaire responses. *The free description of the concern can alter the categorization to NEED+ for school doctor’s health check: If there is concern such as parenthood or the relationship between parent and child, sleep problems, behavior problems in the class, recurrent joint pain/headaches, heel pain, acne, a mole